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Analytical Data Review of Neonatal Perioperative Care in a UK Neonatal Intensive Care Unit - Abstract

Gauthamen Rajendran, Kokila Lakhoo, Arnwald Choi, Frances O’Brien

 

Abstract

Background: There is a paucity of data regarding the perioperative care in neonates.

Objective: To collect data relevant to perioperative care in a neonatal intensive care unit (NICU), with a focus on identifying key areas of clinical care around the time of surgery.

Methods: Perioperative data of neonates who underwent surgical intervention in 2013 within a UK NICU were collected retrospectively. Temperature, blood sugar levels, serum sodium levels, blood gas parameters, weight and fluids used in the perioperative period along with demographic details were collected. The data was analysed for the distribution and trend of temperature, blood sugar and parameters pertaining to fluid, electrolyte and acid-base balance in the perioperative period.

Results: Forty-eight neonatal surgical procedures in 45 neonates were studied. Median gestational age (IQR) at the time of surgery and weight before surgery were 37 (33 to 39) weeks and 2750 (1872 to 2942) grams. The number of surgical procedures for NEC, and abdominal wall defects were 14 and 11 respectively; 23 neonates had surgery for other reasons. Incidence of postoperative hypothermia was 15%. Hyperglycaemia and hypocapnia were more common post-operatively when compared to preoperative findings (63% vs 13% and 19% vs 0% respectively). Hyponatraemia was common preoperatively (42%) but the incidence remained static postoperatively. Hypernatremia was uncommon. A slow and sustained increase in blood sugar levels were noticed in preterm and NEC neonates. Statistically significant weight gain occurred in preterm neonates.

Conclusions: Pre-operative hyponatraemia and post-operative hyperglycemia and hypocapnia require attention. Preterm neonates and neonates with NEC and abdominal wall defects are the high risk groups.

Keywords: newborn, perioperative care, preterm infants, hypothermia, hyperglycemia

 

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